NPIMap

Individual provider Active NPI

Mario Eurico Ravry, M.D.

  • Internal Medicine Physician
  • Atlanta, GA
National Provider Identifier
1922072321
Registry record updated Nov 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
044317 Issued in GA
Practice address
5505 Peachtree Dunwoody Rd NE
Suite 650
Atlanta, GA 30342-1705
Phone
(404) 459-9340
Fax
(404) 459-9347
NPI assigned
Feb 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 044317 GA Primary

Addresses

Primary practice location

5505 Peachtree Dunwoody Rd NE
Suite 650
Atlanta, GA 30342-1705

Mailing address

5505 Peachtree Dunwoody Rd NE
Suite 650
Atlanta, GA 30342-1705
Phone (404) 459-9340

Other identifiers 2

IdentifierTypeStateIssuer
52728736OtherGABLUE CROSS BLUE SHIELD
P00059607OtherRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040520000382 GA Practitioner - Internal Medicine 9931190881 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Hahnemann University College of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

5505 Peachtree Dunwoody Rd
Suite 650
Atlanta, GA 30342-1755
Phone (404) 459-9340

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.97 of 100Reported as individual
Quality
86.67
Promoting interoperability
71
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
044317GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northside Primary Care Professional Services, LLC CurrentSince Sep 1, 2013 Accepting new patients
Northside Primary Care Professional Services,LLC Current Accepting new patients

Locations

1285 Upper Hembree Rd
Ste 205
Roswell, GA 30076
Phone (770) 521-1587

5505 Peachtree Dunwoody Rd
Ste 650
Sandy Springs, GA 30342
Phone (404) 355-4004

1000 Johnson Ferry Rd
Sandy Springs, GA 30342
Phone (404) 851-8737

3350 Paddocks Pkwy
#3350A
Suwanee, GA 30024
Phone (678) 474-9633

3350 Paddocks Pkwy
Suwanee, GA 30024
Phone (678) 474-9633

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257724800000",
    "number": "1922072321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5505 PEACHTREE DUNWOODY RD NE",
            "address_2": "SUITE 650",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421705",
            "telephone_number": "404-459-9340",
            "fax_number": "404-459-9347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5505 PEACHTREE DUNWOODY RD NE",
            "address_2": "SUITE 650",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421705",
            "telephone_number": "404-459-9340",
            "fax_number": "404-459-9347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAVRY",
        "first_name": "MARIO",
        "middle_name": "EURICO",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-14",
        "last_updated": "2009-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "044317",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "52728736",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00059607",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.